Psychosis is a state of mind that involves disruptions in areas of brain functioning including cognition, perception, processing, and emotion. Historically, psychosis was used to refer to any mental health condition that interfered with normal functioning. Currently, the most common definition of psychosis is an episode that causes someone to disconnect in some way from reality.
Individuals experiencing symptoms of psychosis may find it helpful to seek treatment from a mental health professional.
When someone enters a state of mind that does not connect with reality, they may have entered a state of psychosis. One of the primary signs of psychosis are hallucinations or delusions. Hallucinations occur when the senses perceive something that isn’t real and can come in many forms, including auditory, visual, and tactile hallucinations. Delusions, on the other hand, are false beliefs.
Psychosis is not its own condition. Instead, it appears as a symptom of other conditions. Some conditions, medical and psychological, that list psychosis as a primary symptom include:
The terms “psychotic episode” and “psychotic break” most often describe a sudden, sharp disconnect from reality. Psychosis is a frightening experience for many of the people it affects. As many as 3 out of 100 people will have a psychotic episode at some point in their life.
For a psychotic episode to be diagnosed, the symptoms must include some departure from reality. Someone who is deliberately acting abnormally is not having a psychotic episode. Symptoms can include:
- Extreme emotions, particularly aggression and sadness
- Disorganized or incoherent speech
- Attempts to harm oneself or others
- Delusions, or false beliefs
- Inadequate or excessive sleep
- Social isolation or withdrawal
- Suicide or thoughts of suicide
Symptoms of psychosis can also occur in different contexts. Clinicians may differentiate between psychosis caused by ingesting a substance, psychosis related to a mental health condition, or psychosis unrelated to either of these factors.
Psychosis has been linked to reduced grey matter in the brain. It is thought that changes in the brain structure as well as genetics contribute to the development of psychosis. The ingestion of certain substances, such as marijuana, is also linked to psychotic episodes.
Psychosis is most commonly associated with schizophrenia, a severe psychiatric condition that may cause an ongoing loss of contact with reality. Other mental health conditions that may cause psychosis include major depression and bipolar. Substance abuse and chemical withdrawal have also been known to lead to psychosis.
Some medical conditions, such as Parkinson’s disease and Alzheimer’s, are also thought to cause psychosis. In addition, severe infection that has spread to the brain, epilepsy, stroke, brain tumors, and the late stages of AIDS have the potential to cause psychotic episodes, although psychosis is not characteristic of these illnesses.
In rare cases, psychosis may occur in women after childbirth, generally in the first two weeks after delivery. Postpartum psychosis is linked to postpartum depression, but it is far more rare, occurring after only about .1% of births. Risk factors include a previous psychotic episode, bipolar, or a family history of bipolar. The condition is both temporary and treatable, but it is serious: There is a 5% suicide rate associated with postpartum psychosis, and a 4% infanticide rate.
Symptoms of postpartum psychosis include:
- Irrational judgment
These symptoms may be severe. Not all women who develop postpartum psychosis harm themselves or others, but postpartum psychosis can lead to this behavior. Women demonstrating symptoms of postpartum psychosis should seek out professional medical, mental health, or emergency services immediately.
Psychotic depression is characterized by severe depression with symptoms of psychosis. It is also referred to as major depression with psychotic features and delusional depression. In the Diagnostic and Statistical Manual (5th edition), psychotic depression is recorded as a subclassification of major depressive disorder.
In people with severe depression, psychosis often takes the form of delusions. A person with psychotic depression may believe that only bad things are bound to happen to them or that there is little hope for the future. These beliefs, which can lead to suicidal thoughts and actions, can make psychotic depression particularly dangerous.
Due to the high risk for suicidal thinking associated with this type of depression, early diagnosis and treatment is often critical. Antidepressants and antipsychotics have been shown to be effective treatments for psychotic depression.
There is some confusion about the difference between psychosis and schizophrenia. The main distinguishing factor between the two is that psychosis is a symptom while schizophrenia is a diagnosable mental health condition. Psychosis is a common symptom of schizophrenia, but it's also a symptom of many other medical and mental health conditions. Likewise, schizophrenia has other primary symptoms besides psychosis.
Spoiler warning below.
Media portrayals of mental illness are often inaccurate. They may include distortions and exaggerations of the symptoms of mental health conditions as well as incorrect and inconsistent descriptions of particular mental health conditions. In film and television, for example, conditions such as bipolar or schizophrenia are often linked to violent tendencies, even when violence is not typical of the condition being depicted. This kind of representation can lead to further stigmatization of mental health issues. This is especially true of psychosis, which is frequently confused with psychopathy.
- Batman: Although violence is not always a symptom of psychosis, violent individuals depicted in the media are sometimes termed psychotic. The Joker, for instance, a character in the Batman universe, is often described as psychotic when he actually shows symptoms of psychopathy, according to mental health professionals. These two conditions are often combined or correlated incorrectly, leading to an inaccurate understanding of psychosis. This faulty understanding could delay diagnosis and treatment of the condition or cause symptoms to worsen.
- Black Swan (2010): The 2010 film Black Swan depicts a ballerina, Nina, who experiences psychosis. Although some psychiatrists point out that the film does depict psychosis fairly accurately, Nina also suffers from other mental health issues that do not tend to accompany psychosis, such as an eating disorder and obsessive-compulsive behavior. While the portrayal of psychosis might be realistic, the depiction of overlapping mental health issues that are not always directly linked may still be misleading to some.
- Tully (2018): Tully is a 2018 film with a twist ending that reveals the main character, Marlo, has postpartum psychosis. The film’s depiction of postpartum psychosis has been seen as controversial by some. In the film, the night nanny, Tully, is revealed be a hallucination caused by Marlo’s postpartum psychosis. Some warn that the film can be triggering for people with postpartum mental health issues due to its realistic portrayals and the character’s lack of diagnosis and treatment.
- Caron, C. (2018, May 2). Diablo Cody, responding to criticism, says ‘Tully’ is meant to be ‘uncomfortable.’ Retrieved from https://www.nytimes.com/2018/05/02/movies/tully-postpartum-depression-charlize-theron.html
- Early psychosis and psychosis. (n.d.). NAMI. Retrieved from https://www.nami.org/earlypsychosis
- First Episode Psychosis: An Information Guide. (2012). Retrieved from http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/psychosis/first_episode_psychosis_information_guide/Pages/fep_treatment.aspx
- James, S. (2010, December 20). 'Black Swan': Psychiatrists Diagnose Ballerina's Descent. Retrieved from http://abcnews.go.com/Health/Movies/black-swan-psychiatrists-diagnose-natalie-portmans-portrayal-psychosis/story?id=1243687
- MacGill, M. (2017, December 14). What is psychosis? Retrieved from https://www.medicalnewstoday.com/articles/248159.php
- Moye, D. (2011, July 21). Batman Villains Psychoanalyzed By Mental Health Experts. Retrieved from http://www.huffingtonpost.com/2011/07/21/batman-villains-psychoanalyzed_n_901913.html
- Postpartum Psychosis. (n.d.). Retrieved from http://www.postpartum.net/learn-more/postpartum-psychosis
- Psychosis. (n.d.). The New York Times Health Guide. Retrieved from http://health.nytimes.com/health/guides/disease/psychosis/overview.html
- Rothschild, A. J. (2013). Challenges in the treatment of major depressive disorder with psychotic features. Schizophrenia Bulletin, 39(4), 787-796. doi: 10.1093/schbul/sbt046
- Tanap, R. (2017, March 20). Understanding psychotic breaks. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/March-2017/Understanding-Psychotic-Breaks